Provider Demographics
NPI:1497157218
Name:MEADOWS, JETTA (ASW)
Entity Type:Individual
Prefix:
First Name:JETTA
Middle Name:
Last Name:MEADOWS
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:JETTA
Other - Middle Name:
Other - Last Name:KEENEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4520 HIGH CT
Mailing Address - Street 2:
Mailing Address - City:KELSEYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95451-9347
Mailing Address - Country:US
Mailing Address - Phone:530-864-5283
Mailing Address - Fax:
Practice Address - Street 1:149 N MAIN ST
Practice Address - Street 2:SUITE # 210
Practice Address - City:LAKEPORT
Practice Address - State:CA
Practice Address - Zip Code:95453-4832
Practice Address - Country:US
Practice Address - Phone:707-262-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical